Week 12 Intra-op Flashcards
Why do we need a controlled surgical environment?
minimize the spread of infection
What can someone wear in the unrestricted area?
street clothes
(front desk/locker rooms)
What does someone wear in the semi-restricted area?
Surgical attire
cover all hair
(corridors between OR rooms)
What does one wear in the restricted area?
surgical attire
cover all hair
surgical MASK
(OR rooms and scrub sinks)
What are the 3 main tasks of the surgeon?
- determines need for surgical procedure and type
- does the surgery
- post-op care on unit
What are the 3 main tasks of the Anesthesiologist?
- Keeps patient alive (during and shortly after surgery)
- maintain anethesia during surgery (no one wants an awake patient on the table)
- Post-op care while in recovery room or PACU
What are the 6 tasks of the circulating nurse?
- unsterile field
- assess/position pt
- Pt advocate
- ensure OR runs well
- Instigates surgical time out (when they announce the patient )
- Document/gives report
What are the 3 tasks of the scrub nurse?
- Sterile field
- Hands on during surgery
- Passes instruments to surgeon
Which nurse is responsible for the “count” of all materials going into the patient?
both the scrub and surgical nurse
At what point are gowns and gloves put on ?
In the OR with assistance
What factors are considered when deciding type of anesthetic?
- length of procedure
- invasiveness of procedure
- past health HX
- pt/surgeon/anesthetist preference
- emergency and pt just ate?
What induction agent is first given in general anethesia?
propafol - sedative (unconscious)
What is the foundation of anethesia (we help the patient cough this out after)?
Inhalation agents via endotracheal tube
What are 3 examples of regional anesthesia?
- spinal anesthetic - no motor/sensory feeling
- Epidural anesthetic - nerve roots around spine
- local anaesthetic- nerve block
What are 2 good things about regional anesthesia?
- fast recovery
- no NPO required (not intubated) - good for emergency
Is an epidural a one time needle or a catheter for continuous drug delivery?
catheter for continuous drug delivery
What is a spinal anethesia?
one time injection of anethetic and analgesia
- subarachnoid space (below L2)
- mixes with CSF
- autonomic, sensory, motor block
What is an epidural?
injection of anethetic/analgesia in epidural space (lumbar or thoracic)
- drug binds to nerve root that enter/exit spinal cord
- sensory fibres blocked
- motor fibers not blocked
- can be one time dose or PCA
Can a patient go back to the unit with an epidural?
Yes
Would we anticipate a headache with an epidural or spinal and why?
Spinal b/c they may leak CSF. The brain doesn’t like this
What do we monitor in people with Spinal/Epidural?
Hypotention
Pruritis
Urinary retention
N&V
Infection / Septicemia
Epidural hematoma (bleeding btwn inside skull and outer covering of brain)
What is procedural sedation (conscious sedation)?
Mild or heavy deep IV sedation for minor surgery or diagnostic procedures
What needs to be monitored when person is under deep procedural sedation?
Airway
what two meds are used for procedural sedation?
- fentanyl (opioid)
- Midazolam (sedative/amnesic)
What is a rare but life threatening event that can be triggered by anesthesia?
Malignant Hyperthermia
What medication can cause malignant hyperthermia?
Succinylcholine
What happens if someone experiences malignant hyperthermia?
- hypermetabolism- hyperthermia
- hypoxemia - hypercarbia
- tacycardia - tachypnea-dysrhythmias
What saves a person in malignant hyperthermia?
Dantraline sodium
cool the patient
What is the key to preventing malignant hyperthermia?
family history (highly genetic)
- make sure to ask !
